I am glad to receive this letter from a medical student. Being a medical student, it should be encouraged that who can establish the questions and then study them by themselves. I have answered the questions below, one by one.
With regard to reconstruction, the gastrocnemius muscle is a good donor for defects of the upper and middle thirds of the leg and functional muscle transfer. According to previous experience, the medial and lateral portions of the gastrocnemius muscle can be used as flap and the functions of the leg and foot are not affected. In my series, four patients have had five pregnancies after resection of the gastrocnemius muscle. They reported no problems with ambulation or daily activities during pregnancy or thereafter. The most weight gain was 25 kg in these patients. There were several amateur sportswomen in the series who practiced badminton, tae kwon do, tennis, yoga, running, and aerobic dancing. They reported no significant differences in function after operation.
I agree with Ms. Yang that there are some limitations in the Cybex test, but the Cybex test can provide objective data about the recovery of the muscle power. My coauthors and I followed the test as other published studies did. In fact, our patients could run on the training equipment under different settings. From a practical viewpoint, I can say that the patients do well in their daily activities and exercises.
The World Medical Association’s Declaration of Helsinki was created in 1964 and amended thereafter under the association’s general assembly. Since medical progress is based on research, the Declaration of Helsinki provides the idea of patient safety. In Taiwan, on the first day of internship, physicians swear on the Declaration of Geneva that “the health of my patient will be my first consideration.” The people in the study asked to change their appearance to fit their ideal body image under independent thinking. They had been persecuted for years, and their conditions made them sad and unhappy during those years. This method provided them with a chance to change their body image quickly and effectively, and it made them feel more self-confident than they had before. The surgical procedure is similar to harvesting the gastrocnemius muscle for reconstructive procedures, so we did not apply to the institutional review board.
The criteria of beauty will change over time. If people feel puzzled about their body image, is it a disease or not? Of those who undergo surgical interventions such as augmentation mammaplasty, rhinoplasty, double eyelid creation, and face lift, should we call them “normal people” or “patients”? Do plastic surgeons perform cosmetic surgery on “customers” or “patients”? Personality is internal and appearance is external. There is no conflict between internal and external beauty. To overemphasize one or the other will restrict our minds and thinking.
I believe that no physician would perform procedures that turn a healthy subject into a patient and violate their conscience. The subtotal resection of the gastrocnemius muscle is still an effective method of calf reduction in my experience.
Chien-Hsing Wang, M.D.
Division of Plastic Surgery
Department of Surgery
Buddhist Tzu Chi General Hospital
No. 707 Chung-Yang Road
Hualien, Taiwan 970
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